Successful Management of Pediatric Patients with Low-Risk Febrile Neutropenia Using a Clinical Care Pathway in Egypt

Abstract

Background Criteria for home management of low-risk febrile neutropenia remain challenging in supportive care. Careful selection of low-risk febrile neutropenic pediatric patients can improve outcomes and decrease complications. In the current study, we implemented a clinical pathway for pediatric patients presenting to the emergency room department with low-risk febrile neutropenia by using strict inclusion criteria. Materials and Methods This is a prospective study from December 2021 to September 2022; all patients presented to the emergency room department were screened for pathway evaluation, and risk stratification was performed using a strict checklist. Patients were included if they met the low-risk criteria. Thorough clinical and laboratory assessments were performed on these patients. All patients started oral antibiotics and were instructed about alarming signs. Patients were followed up at the outpatient clinic on days 3 and 7. Results Two hundred and three patients with 200 episodes of low-risk febrile neutropenia were enrolled; one hundred and ten were males, and 90 were females; underlying hematological malignancies accounted for 54.0%. On day three, 181 patients out of 200 were afebrile for 24 hours (90.0%), and 47.5% were still neutropenic. At day seven, all study patients were afebrile, had recovering counts, and stopped antibiotics regardless of the count. Absolute neutrophil count recovery on day seven was achieved in 95.5% of patients. Conclusion Our inclusion criteria for patients with low-risk febrile neutropenia proved to be safe without deaths or intensive care unit admission and successful with the lowest admission rate, so it can be used for a stewardship program to avoid unnecessary patient admissions and help healthcare givers to optimize patient allocation and follow-up safely.